This book describes a program of research in computable structure theory. The goal is to find definability conditions corresponding to bounds on complexity which persist under isomorphism. The results apply to familiar kinds of structures (groups, fields, vector spaces, linear orderings Boolean algebras, Abelian p-groups, models of arithmetic). There are many interesting results already, but there are also many natural questions still to be answered. The book is self-contained in that it includes necessary background material from recursion theory (ordinal (...) notations, the hyperarithmetical hierarchy) and model theory (infinitary formulas, consistency properties). (shrink)

The contentions of this paper are essentially two. One is that truth does not consist of verifiability—and still less of verification—in the sense in which this has been maintained by some pragmatists, operationalists, and positivists. The other is that in a certain other sense of “verifiability”, which will be described, truth is the same thing as verifiability. The paper, it should be understood, attempts only to make clear what is and what is not the relation between truth and verifiability. (...) It does not attempt in addition to carry the analysis of verification itself to the point where it would, by implication, furnish a terminal answer to the question, what is truth. The latter task, because of space limitations, must be reserved for some future occasion. (shrink)

At Theaetetus 163d-164b Socrates objects to the thesis that knowledge is perception by pointing out that a man who has seen something can still remember it, and so has knowledge of it; but this is impossible, if knowledge is perception, since he is no longer perceiving it.To this Protagoras is made to reply with two sentences at 166b 1–4: .Cornford translates ‘ For instance, do you think you will find anyone to admit that one's present memory of a past (...) impression is an impression of the same character as one had during the original experience, which is now over? It is nothing of the sort’.Cornford understands this as the suggestion that the memory and the original perception are of different things: ‘ All that the objection in fact established was that “ perception” must be stretched to include awareness of memory images’. So too Lee: ‘Protagoras’ “way out”… appears to be to say that what we now know is not properly X but rather our memory trace of X - some present πά θ ο ς quite distinct from X and very different from that ’. McDowel. (shrink)

At Theaetetus 163d-164b Socrates objects to the thesis that knowledge is perception by pointing out that a man who has seen something can still remember it, and so has knowledge of it; but this is impossible, if knowledge is perception, since he is no longer perceiving it.To this Protagoras is made to reply with two sentences at 166b 1–4:.Cornford translates ‘ For instance, do you think you will find anyone to admit that one's present memory of a past impression (...) is an impression of the same character as one had during the original experience, which is now over? It is nothing of the sort’.Cornford understands this as the suggestion that the memory and the original perception are of different things: ‘ All that the objection in fact established was that “ perception” must be stretched to include awareness of memory images’. So too Lee: ‘Protagoras’ “way out”… appears to be to say that what we now know is not properly X but rather our memory trace of X - some present πά θ ο ς quite distinct from X and very different from that ’. McDowel. (shrink)

The first solid bit of argumentation you get in Plato's Phaedo goes something like this: Whatever comes to be, comes to be from its opposite. If at a certain time t a given thing a begins to be F, before that time t it must have been non-F. Wherever a pair of predicates, F and G, are genuine contradictories; where, that is, they stand to each other in the same relation as F stands in to non-F; it is necessarily true (...) that if a began to be F at t before then a was G. The only trouble comes from the difficulty of finding substitutes for F and G that people will allow to be genuine contradictories. It the butter began to be soft at four o'clock, we may suggest, before four it was hard. A tiresome opponent will retort that there is a state in which butter cannot properly be called either hard or soft. We try again: If Ann began to be asleep at eight, before eight she was awake; if my shirt became dirty on Tuesday, before Tuesday it was clean; if Bonzo died last week, before last week he was alive. And when the advocate of the borderline state reminds us of the various twilight areas of consciousness or cleanliness, we are reduced to legislation: “asleep” shall henceforth apply to every mental state short of complete wakefulness, “alive” to every condition of the body before the onset of putrefaction, “clean” to every shirt incapable of producing a certain measurable discoloration in the water in which it is washed. “Let F and G be contradictories”, we still guardedly maintain: “then if a comes to be F at time t, before time t a was G”. (shrink)

The first solid bit of argumentation you get in Plato's Phaedo goes something like this: Whatever comes to be, comes to be from its opposite . If at a certain time t a given thing a begins to be F , before that time t it must have been non- F . Wherever a pair of predicates, F and G , are genuine contradictories; where, that is, they stand to each other in the same relation as F stands in to (...) non- F ; it is necessarily true that if a began to be F at t before then a was G . The only trouble comes from the difficulty of finding substitutes for F and G that people will allow to be genuine contradictories. It the butter began to be soft at four o'clock, we may suggest, before four it was hard. A tiresome opponent will retort that there is a state in which butter cannot properly be called either hard or soft. We try again: If Ann began to be asleep at eight, before eight she was awake; if my shirt became dirty on Tuesday, before Tuesday it was clean; if Bonzo died last week, before last week he was alive. And when the advocate of the borderline state reminds us of the various twilight areas of consciousness or cleanliness, we are reduced to legislation: “asleep” shall henceforth apply to every mental state short of complete wakefulness, “alive” to every condition of the body before the onset of putrefaction, “clean” to every shirt incapable of producing a certain measurable discoloration in the water in which it is washed. “Let F and G be contradictories”, we still guardedly maintain: “then if a comes to be F at time t , before time t a was G ”. (shrink)

Undercover filming is a method commonly used by animal activist groups to expose animal cruelty and it is important to consider the effects of publically releasing video footage of cruel practices on the viewers’ mental health. Previously, we reported that members of the Australian public were emotionally distressed soon after viewing media broadcasts of cruelty to Australian cattle exported for slaughter in Indonesia in 2011. To explore if there were any long term impacts from exposure to media on this issue, (...) a self-selecting group of 15 people who were exposed to a documentary exposé of the cruelty were re-interviewed 12 months later. Nearly all recalled their strong initial reaction to the footage. Approximately one half of the respondents who initially had had a strong emotional reaction to the footage reported negative reactions that were still strong even after this period of time. They reported potential triggers for these feelings. Of the rest, some managed to internalise their feelings. Approximately one half of respondents were unaware of continued live export exposés, suggesting less prominent media coverage. Despite the aversion and repulsion reported after viewing the initial coverage, most respondents said they would choose to watch another broadcast of animal cruelty and nearly all supported undercover investigations as a means of revealing cruelty to animals. We conclude that many people viewing footage of cruelty to animals will have long term memory of this, but that they would prefer to be informed about the issues and not be protected from them. (shrink)

Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A (...) home-sent questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)

I have argued that without an adequate solution to the knower paradox Fitch's Proof is- or at least ought to be-ineffective against verificationism. Of course, in order to follow my suggestion verificationists must maintain that there is currently no adequate solution to the knower paradox, and that the paradox continues to provide prima facie evidence of inconsistent knowledge. By my lights, any glimpse at the literature on paradoxes offers strong support for the first thesis, and any honest, non-dogmatic reflection on (...) the knower paradox provides strong support for the second. Whether verificationists want to go the route I've suggested is not for me todecide. As in the previous section my aim has been that of defending the mere viability of verificationism in the face of what many, many philosophers have taken to be its death-knell, namely Fitch's Proof. But, as the final objection makes clear, showing that verificationism can live in the face of Fitch's Proof is one thing; showing that it should live is another project. If nothing else, I hope that this papershows that verificationists still have a project to pursue; Fitch's Proof, contrary to popular opinion, need not bury verificationism.13. (shrink)

The central classical liberal insight is that private property appears both to protect personal liberty and to promote general productivity. By way of philosophically clarifying this insight, Escape from Leviathan (EfL) posits the extreme classical liberal, or libertarian, Compatibility Thesis: there is no long-term, systemic, practical conflict among economic rationality, interpersonal liberty, human welfare, and private-property anarchy (i.e., four plausible and relevant theories of these that are presupposed, or entailed, by libertarianism and consonant social science). The review (Liberty, November 2002) (...) holds that this extreme version is probably false and suggests that perhaps even EfL’s author would agree. He (still) does not, although he remains open to argument. But what anyone happens to believe at any particular moment is a piece of fleeting biography that is irrelevant to the truth of the thesis or the soundness of the arguments in EfL. (shrink)

‘To attempt to say anything new about Horace may seem absurd.’ To attempt to say anything new about the Roman Odes may seem still more absurd; my purpose, nevertheless, is to reconsider the lines of Carm. 3.3 set out above, and to reinterpret an argument begun by the editor of the Delphin Horace in which the authority of Bentley is against me. My question is: what does Horace mean the reader to understand by describing Augustus as drinking nectar ‘purpureo (...) ore’? (shrink)

‘To attempt to say anything new about Horace may seem absurd.’ To attempt to say anything new about the Roman Odes may seem still more absurd; my purpose, nevertheless, is to reconsider the lines ofCarm. 3.3 set out above, and to reinterpret an argument begun by the editor of the Delphin Horace (1691) in which the authority of Bentley is against me. My question is: what does Horace mean the reader to understand by describing Augustus as drinking nectar ‘purpureo (...) ore’? (shrink)

Why is it that philosophers find it so hard to come to agreement? Many disputes that have gone on for centuries or even millennia are still unresolved, even though there has been increased conceptual sophistication on the part of the contending parties. Consider, for example, the question of free will, where libertarians still contest the field with determinists and compatibilists.

Primarily using philosophy, but also some social science, Escape from Leviathan (EfL) explains and defends what it calls an extreme version of the implicit ‘classical liberal compatibility thesis’: liberty, welfare, and anarchy are overwhelmingly complementary in normal practice (rationality is added for its intimate theoretical connections to these categories). This is done using theories, not definitions, of each concept. This important thesis is entirely positive. Therefore, somewhat unusually, all normative issues are avoided as irrelevant distractions in this context. In addition, (...) the epistemology used is also unorthodox. A justificationist, or foundationalist, approach would be literally illogical: the self-refuting trilemma faced by ‘supporting justifications’ (as regards arguments and evidence) is of entailing infinite regresses, dogmatic starting points, or circularities. Consequently, critical rationalism is assumed: conjecture and criticism are all that is possible. Thus all aspects of the conjectured thesis are explained and defended from criticism as thoroughly as the book can encompass. It is concluded that the thesis has not been refuted and so may be critically preferred. (However, this could all still be viewed as a ‘justification’ by those thus inclined.) All of this is made clear enough in the short introductory chapter and repeated where relevant throughout. Yet some reviews do not have a firm grasp of the specific project and so reject it with unsound criticisms. We now turn to one such example. (shrink)

ONE OF HUME’S ARGUMENTS IN "OF MIRACLES" CONCLUDES (A) THAT MIRACLES IN DIFFERENT RELIGIONS ARE CONTRARY FACTS, AND (B) THAT ANY MIRACLE IN FAVOR OF ONE RELIGION IS EVIDENCE AGAINST ALL OTHERS. I ARGUE THAT WHILE (A) IS ABSURD, (B) IS APPLICABLE TO CHRISTIANITY IN VIRTUE OF ITS EXCLUSIVIST CLAIMS. IT WAS ACCEPTED BY THE EARLY FATHERS AND STILL HAS TO BE ASSUMED BY ALL BUT THE MOST DIFFIDENT CHRISTIANS.

Contra critical rationalism, the response begins by referring to “the variety of internalist and externalist versions of foundationalism” (Liberty, December 2002). But it makes no attempt to explain or defend any of them. Hence, no further criticism is due here. The response then argues that, “The critical rationalist method seems to suggest that Lester’s extreme compatibility thesis is probably false” because—quoting Escape from Leviathan (EfL)—“bold universal theories might be false, and probably are” and yet “he doesn’t think the thesis is (...) probably false”. And so this is, by implication, an inconsistent belief. But the Compatibility Thesis (CT) is not one of the “bold universal theories” of science. The review and the response appear, at times, to assume that the CT is a bold universal theory about the perfect compatibility of applying the relevant conceptions, or theories, of rationality, liberty, welfare, and anarchy. Then, at other times, they assert that it is not bold at all but merely about definitions designed to be compatible. In fact, the CT asserts both that there are no theoretical incompatibilities among relevant and plausible versions of the theories, and that there are no actual long-term, systemic, and practical conflicts among applying them. That is still a bold theory (perhaps even most libertarians would disagree with it), but it’s not a universal thesis of perfect compatibility. And if it were good practice to reject a theory just because of its boldness, then all scientific theories would be immediately rejected without even trying to produce a falsification. In any case, as stated in the reply to the review, anyone’s mere beliefs are irrelevant to the truth of objective theories and the soundness of objective arguments. (shrink)

Very few scientists today question the fact that information, together with matter and energy, is one of the three constructs forming the ontology of the universe. However, there is still a long way to go before in order to establish the interrelations between information and energy and information and matter, as Einstein did between matter and energy. In this paper, after introducing the energy, matter, information model, which covers the three constructs and their relationships, we illustrate real examples—two qualitative (...) and two quantitative—of the interrelations between energy and information. This closes the open question with respect to the interrelationship between energy and information. (shrink)

The “free world” was the political rhetoric used during the Cold War in contrast to the “communist” countries. However, the “free world” was manifestly never free: the state considerably interfered with people in their persons and their property. And the “communist” countries were manifestly never communist in the Marxist sense: there was no common ownership of the means of production with the absence of social classes, money, and the state. It would have been more accurate to call them the “authoritarian (...) world” and the “totalitarian world”. Today the “free world” is sometimes still used, but Western countries remain authoritarian in terms of taxation and restrictive legislation. The, by implication, “unfree world” is largely only somewhat more authoritarian. Why does this continuing authoritarianism exist in the West? (shrink)

Kukathas’s proposed libertarian dilemma is introduced and two key criticisms of it stated. The following critical commentary then makes several main points. Kukathas’s account of libertarianism offers no theory of liberty at all, nor a coherent account of aggression. Consequently, he cannot see that his “Federation of Liberty” is not libertarian by a basic understanding of morals and non-invasive liberty, still less by a more precise theory of liberty. In trying to explain his “Union of Liberty,” Kukathas evinces considerable (...) confusion about the nature of libertarianism. His argument that a monopoly legal system is inevitable is also neither plausible nor libertarian. He has apparently overlooked the cogent arguments against Nozickian minarchy, and in favor of anarchy. It is concluded that the neglect of libertarian theories of liberty and anarchy is the underlying problem. (shrink)

In a previous paper a stochastic foundation was proposed for microphysics: the nonrelativistic and relativistic domains were shown to be connected with two different approximations of diffusion theory; the relativistic features (Lorentz contraction for the coordinate standard deviation, covariant diffusion equation) were not derived from the relativistic formalism introduced at the start, but emerged from diffusion theory itself. In the present paper these results are given a new presentation, which aims at elucidating not the foundations of quantum mechanics, but those (...) of relativity. This leads to a discussion of points still controversial in the interpretation of relativity. In particular two problems appear in a new light: the character of time and length alterations, and the privileged role of the velocityc. Besides, the question of a possible limitation of relativity (and more generally of the laws of mechanics) in the domain of particle substructure is raised and supported by exemples drawn from the hydrodynamical model of a spinned particle. Suggestions are presented for the possibility of a deeper conceptual unification of special and general relativity. (shrink)

Spatial and temporal heterogeneity are often described as important factors having a strong impact on biodiversity. The effect of heterogeneity is in most cases analyzed by the response of biotic interactions such as competition of predation. It may also modify intrinsic population properties such as growth rate. Most of the studies are theoretic since it is often difficult to manipulate spatial heterogeneity in practice. Despite the large number of studies dealing with this topics, it is still difficult to understand (...) how the heterogeneity affects populations dynamics. On the basis of a very simple model, this paper aims to explicitly provide a simple mechanism which can explain why spatial heterogeneity may be a favorable factor for production. We consider a two patch model and a logistic growth is assumed on each patch. A general condition on the migration rates and the local subpopulation growth rates is provided under which the total carrying capacity is higher than the sum of the local carrying capacities, which is not intuitive. As we illustrate, this result is robust under stochastic perturbations. (shrink)

The occurrence of hiccoughs (hiccups) is very widespread and yet their neuronal origin and physiological significance are still unresolved. Several hypotheses have been proposed. Here we consider a phylogenetic perspective, starting from the concept that the ventilatory central pattern generator of lower vertebrates provides the base upon which central pattern generators of higher vertebrates develop. Hiccoughs are characterized by glottal closure during inspiration and by early development in relation to lung ventilation. They are inhibited when the concentration of inhaled (...) CO2 is increased and they can be abolished by the drug baclofen (an agonist of the GABAB receptor). These properties are shared by ventilatory motor patterns of lower vertebrates, leading to the hypothesis that hiccough is the expression of archaic motor patterns and particularly the motor pattern of gill ventilation in bimodal breathers such as most frogs. A circuit that can generate hiccoughs may persist in mammals because it has permitted the development of pattern generators for other useful functions of the pharynx and chest wall muscles, such as suckling or eupneic breathing. BioEssays 25:182–188, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

The female reproductive axis in mammals is a highly complex dynamic system which goes through different transient or absorbent states during the course of a life-time. Little is known about the mechanisms controlling this system during fetal life and at birth, although it has been shown in numerous species, including primates, that the whole machinery is already functioning . After a delay ranging from a few days to a few weeks, according to the species, the reproductive axis becomes quiescent and (...) activity apparently resumes only at the time of puberty. Here again understanding of the phenomenon is still limited. (shrink)

We are printing in its entirety the discussion document which sets out a code of professional conduct for nurses published by the Royal College of Nursing in November 1976 together with commentaries by the Assistant Secretary of the British Medical Association, a professor of nursing studies, student nurses and a lawyer. The image of the nurse is still that of one of Florence Nightingale's young ladies or of a member of a religious order who is wholly dedicated to caring (...) for the sick. Today, as this document and the comments upon it show, 'dedication' is still part of the motive which leads a man or woman to become a nurse but in addition, and this is where the public may be ignorant or choose to be ignorant, nursing offers a career where intellectual achievement and the satisfaction of a demanding job bring their proper financial reward and place in the professional community. We are grateful to the Royal College of Nursing for permission to publish this document. (shrink)

We will show that there is a strong form of emergence in cell biology. Beginning with C.D. Broad's classic discussion of emergence, we distinguish two conditions sufficient for emergence. Emergence in biology must be compatible with the thought that all explanations of systemic properties are mechanistic explanations and with their sufficiency. Explanations of systemic properties are always in terms of the properties of the parts within the system. Nonetheless, systemic properties can still be emergent. If the properties of the (...) components within the system cannot be predicted, even in principle, from the behavior of the system's parts within simpler wholes then there also will be systemic properties which cannot be predicted, even in principle, on basis of the behavior of these parts. We show in an explicit case study drawn from molecular cell physiology that biochemical networks display this kind of emergence, even though they deploy only mechanistic explanations. This illustrates emergence and its place in nature. (shrink)

In this article I argue that the value of epistemic justification cannot be adequately explained as being instrumental to truth. I intend to show that false belief, which is no means to truth, can nevertheless still be of epistemic value. This in turn will make a good prima facie case that justification is valuable for its own sake. If this is right, we will have also found reason to think that truth value monism is false: assuming that true belief (...) does have value, there is more of final epistemic value than mere true belief. (shrink)

We will show that there is a strong form of emergence in cell biology. Beginning with C.D. Broad’s classic discussion of emergence, we distinguish two conditions sufficient for emergence. Emergence in biology must be compatible with the thought that all explanations of systemic properties are mechanistic explanations and with their sufficiency. Explanations of systemic properties are always in terms of the properties of the parts within the system. Nonetheless, systemic properties can still be emergent. If the properties of the (...) components within the system cannot be predicted, even in principle, from the behavior of the system’s parts within simpler wholes then there also will be systemic properties which cannot be predicted, even in principle, on basis of the behavior of these parts. We show in an explicit case study drawn from molecular cell physiology that biochemical networks display this kind of emergence, even though they deploy only mechanistic explanations. This illustrates emergence and its place in nature. (shrink)

Researchers are concerned about whether manipulations have the intended effects. Many journals and reviewers view manipulation checks favorably, and they are widely reported in prestigious journals. However, the prototypical manipulation check is a verbal (rather than behavioral) measure that always appears at the same point in the procedure (rather than its order being varied to assess order effects). Embedding such manipulation checks within an experiment comes with problems. While we conceptualize manipulation checks as measures, they can also act as interventions (...) which initiate new processes that would otherwise not occur. The default assumption that manipulation checks do not affect experimental conclusions is unwarranted. They may amplify, undo, or interact with the effects of a manipulation. Further, the use of manipulation checks in mediational analyses does not rule out confounding variables, as any unmeasured variables that correlate with the manipulation check may still drive the relationship. Alternatives such as nonverbal and behavioral measures as manipulation checks and pilot testing are less problematic. Reviewers should view manipulation checks more critically, and authors should explore alternative methods to ensure the effectiveness of manipulations. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Starmaking brings together a cluster of work published over the past 35 years by Nelson Goodman and two Harvard colleagues, Hilary Putnam and Israel Scheffler, on the conceptual connections between monism and pluralism, absolutism and relativism, and idealism and different notions of realism -- issues that are central to metaphysics and epistemology. The title alludes to Goodman's famous defense of the claim that because all true representations of stars and other objects are human creations, it follows that in an important (...) sense the stars themselves are made by us. More generally, the argument moves from the fact that our right representations are constructed by us to the claim that the world itself is similarly constructed. Starmaking addresses the question of whether this seeming paradox can be turned into a serious philosophical view. Goodman and Putnam are sympathetic; Scheffler is the critic. Although many others continue to write about pluralism, relativism, and constructionalism, Starmaking brings together the protagonists in the debate since its beginnings and follows closely its still developing form and substance, focusing sharply on Goodman's claim that "we make versions, and right versions make worlds.". (shrink)

In its most basic form, Simple Reliabilism states that: a belief is justified iff it is formed as the result of a reliable belief-forming process. But so-called New Evil Demon cases have been given as counterexamples. A common response has been to complicate reliabilism from its simplest form to accommodate the basic reliabilist position, while at the same time granting the force of NED intuitions. But what if despite initial appearances, Simple Reliabilism, without qualification, is compatible with the NED intuition? (...) What we can call the Dispositionalist Response to the New Evil Demon problem is fascinating because it contends just that: Simple Reliabilism is fully compatible with the NED intuition. It is claimed that all we need to do to recognize their compatibility is appreciate that reliability is a dispositional property. In this paper I shall critically evaluate the Dispositionalist proposal. (shrink)

Objective Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians’ attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus. Design, Setting, Participants A survey of resident/fellow physicians and internal (...) medicine attendings at an academic medical center, May to August 2013. Measurements We used a 24-item, internet-based survey assessing physician-respondents’ demographic characteristics, knowledge, and attitudes regarding decisional authority for adult VA-ECMO. Qualitative narratives were also collected. Main Results A total of 179 physicians completed the survey (15 percent response rate); 48 percent attendings and 52 percent residents/ fellows. Only 32 percent of the respondents indicated that a surrogate’s consent should be required to discontinue VA-ECMO; 56 percent felt that physicians should have the right to discontinue VA-ECMO over a surrogate’s objection. Those who self-reported as “knowledgeable” about VA-ECMO, compared to those who did not, more frequently replied that there should not be presumed consent for VA-ECMO (47.6 percent versus 33.3 percent, p = 0.007), that physicians should have the right to discontinue VAECMO over a surrogate’s objection (76.2 percent versus 50 percent, p = 0.02) and that, given its cost, the use of VA-ECMO should be restricted (81.0 percent versus 54.4 percent, p = 0.005). Conclusions Surveyed physicians, especially those who self-reported as knowledgeable about VA-ECMO and/or were specialists in pulmonary/ critical care, favored a medical locus of decisional authority for VA-ECMO. VA-ECMO is complex, and the data may (1) reflect physicians’ hesitance to cede authority to presumably less knowledgeable patients and surrogates, (2) stem from a stewardship of resources perspective, and/or (3) point to practical efforts to avoid futility and utility disputes. Whether these results indicate a more widespread reversion to paternalism or a more circumscribed usurping of decisional authority occasioned by VA-ECMO necessitates further study. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:An Exposition of The Divine Names, The Book of Blessed Dionysius by Thomas AquinasMichael J. Rubin, Elizabeth C. Shaw, and Staff*AQUINAS, Thomas. An Exposition of The Divine Names, The Book of Blessed Dionysius. Translated and edited with an introduction by Michael A. Augros. Merrimack, N.H.: Thomas More College Press, 2021. xxv + 549 pp. Cloth, $65.00The profound influence that Pseudo-Dionysius had on Aquinas’s thought, especially in his metaphysics (...) of participation and his apophatic theology, has been known for some time now, thanks to the excellent work of such scholars as Fran O’Rourke. One would therefore think that Aquinas’s Exposition of the Divine Names (his only commentary on the works of Pseudo-Dionysius) would have been translated a lot sooner. This delay is assuredly due not just to the difficulty of translating this work but also to a certain embarrassment felt by Thomists over Aquinas’s sincere belief that the “Dionysius” who wrote the Divine Names was the Areopagite whose conversion at the teaching of St. Paul is mentioned in the Acts of the Apostles. That the author calling himself “Dionysius” was in fact a theologian writing in the fifth or sixth centuries has been well established by modern scholarship. Hence, Thomists may have felt tempted to discount or at least pass over the influence of this author on Aquinas since it is discomfiting to think that the Church’s greatest theologian accorded such authority to an imposter.Michael Augros tackles these concerns head-on in the excellent introduction to his new translation of the Divine Names commentary. First, Augros points out that in past centuries a pseudonym was usually not an act of forgery but, rather, a way of concealing the author’s identity, which an early Christian theologian might well decide to do either out of humility or out of a desire “to avoid provoking certain prejudices” in those who disagreed with him in contemporary theological disputes. Moreover, it is likely that the work was never intended for the general public (who could easily mistake the pseudonym as genuine) but, rather, was written for those “already initiated in a particular Neoplatonic school of Christian theology,” who would recognize the author as being “one of their own” but without knowing his precise identity. Finally, in taking the particular name of “Dionysius,” the author of the Divine Names was indicating his intention for the work: Just as the biblical Dionysius was a Greek philosopher who converted to Christianity, so the works of Pseudo-Dionysius [End Page 345] are an attempt to reconcile Greek philosophy with the Christian faith.It therefore seems likely, as Augros observes, that Aquinas would still have accorded a great deal of respect to the Divine Names even if he had learned the truth of the author’s identity. The work would not have had the same deuterocanonical authority for him that comes with being written by a direct disciple of St. Paul himself, but “the inherent cogency, coherence, and beauty” of Pseudo-Dionysius’s theology would have been the same. Hence, Pseudo-Dionysius would surely have earned from Aquinas the “docile attitude” appropriate “for a philosopher and theologian of the first order, such as Boethius.”That Aquinas was right to see the author of the Divine Names as a master philosopher and theologian becomes evident when one dives into the text itself, in which Aquinas sees a truly dazzling order, both externally and internally. According to Aquinas, the Divine Names discusses those truths about God of which there are intelligible likenesses in creatures, such as goodness or wisdom, whereas the truths about God of which there are sensible likenesses (for example, “when God is called a lion, or a rock”) are treated by Pseudo-Dionysius in The Symbolic Theology; meanwhile, in the lost or fictional work The Divine Characteristics, Dionysius claims to have treated those truths about God (such as the Trinity) that cannot be known through any likenesses in creatures.Aquinas finds a still more intricate order within the Divine Names itself. Since this work is dedicated to “the divine names by which the processions of God to creatures are manifested,” the plan of the work... (shrink)

Given the proliferation of research regarding the ethical development of students in general, and business students in particular, it is difficult to draw conclusions from the contradictory results of many studies. In this meta-analysis of empirical studies from 1985 through 1994, the relationships of gender, age and undergraduate major to the ethical attitudes and behavior of business students are analyzed. The results indicate that female students exhibit stronger ethical attitudes than males. The same is also true for older versus younger (...) students. However, the relationship with undergraduate major is still difficult to interpret. (shrink)

The use of platelet rich plasma as a novel treatment is discussed in the context of a qualitative research study comprising 38 interviews with sports medicine practitioners and other stakeholders working within the English Premier League during the 2013–16 seasons. Analysis of the data produced several overarching themes: conservatism versus experimentalism in medical attitudes; therapy perspectives divergence; conflicting versions of appropriate evidence; subcultures; community beliefs/practices; and negotiation of medical decision-making. The contested evidence base for the efficacy of PRP is presented (...) in the context of a broader professional shift towards evidence based medicine within sports medicine. Many of the participants while accepting this shift are still committed to casuistic practices where clinical judgment is flexible and does not recognize a context-free hierarchy of evidentiary standards to ethically justifiable practice. We also discuss a tendency in the data collected to consider the use of deceptive, placebo-like, practices among the clinician participants that challenge dominant understandings of informed consent in medical ethics. We conclude that the complex relation between evidence and ethics requires greater critical scrutiny for this emerging specialism within the medical community. (shrink)

What are we to make of the cultural nonconformity of hardcore/punks? Is there any ethical value in the pursuit of cultural nonconformity? Distinct moral justifications can be teased from the lyrics of the hardcore/punk bands that we have grown up with and still love. The best explanation of what makes cultural nonconformity morally valuable, we believe, comes from John Stuart Mill: that it opens up new cultural space to oneself and to others, permitting "new and original experiments of living.".

As Ihde points out, he has undertaken the perilous task of writing a book about a philosopher who is still actively at work and developing his thought. Yet he has succeeded in providing the reader with an access to Ricoeur’s work which makes it plain to those who are not familiar with Ricoeur why he has achieved such prominence. After an illuminating introduction, Ihde devotes the opening chapters of his book to Ricoeur’s "structural phenomenology," a more or less orthodox (...) Husserlian employment of the phenomenological method. This is exemplified by Ricoeur’s "eidetic" analysis of the will in Freedom and Nature and in a modified way in Fallible Man. Ihde then passes on to Ricoeur’s later "hermeneutic phenomenology," a phenomenology of interpretation which is to be found in his analysis of myth and symbol in The Symbolism of Evil. The growing interest in hermeneutics explains Ricoeur’s concern with the problem of language, which is Ricoeur’s current line of interest. The study translated under the title Freud and Philosophy is discussed in this context. There is much to recommend Ricoeur to the English reader, not the least of which is his open admission of the limits of the phenomenological method and his attempt to complement it with the "objectivistic" approaches, and particularly in recent years with linguistic analysis and the various linguistic sciences. For Ricoeur, no one philosophical method is exclusively valid; the true method is a dialectic between various and even opposed methods. There is an extensive bibliography of Ricoeur’s works and a helpful index of names and topics.—J.D.C. (shrink)

Bucher reads Heidegger’s thought as a contribution to the "problem of the concept". Heidegger says in Being and Time that the meaning of Being must be "conceived in a way of its own, essentially contrasting with the concepts in which entities acquire their determinate signification." Heidegger’s thought is construed, therefore, not as an attack upon all conceptualization but as an attempt to renew the conceptual terms in which we think upon Being. The focus of Bucher’s analysis is Heidegger’s critique of (...) Western metaphysics which he interprets as Heidegger’s critique of the traditional mode of conceptualization. Since it is clear that Heidegger himself does not consciously formulate his problem in this way, Bucher claims that he is dealing with the unthought implications of Heidegger’s work, rather than with his explicit expressions. This accords with Heidegger’s own counsel that we look for what is still unthought in a philosopher’s thought. The heart of the book is the last three chapters in which a "search for a new understanding of the concept" is undertaken, and in which Bucher argues that Heidegger’s repudiation of metaphysics constitutes an implicit, formally negative mode of conceptualizing a post-metaphysical understanding of Being. This contradicts the letter of Heidegger’s thought, Bucher concedes, but is in keeping with Heidegger’s own approach towards the great thinkers. Bucher’s proposal is quite interesting and is perhaps a sign of a new movement among philosophers to appropriate for philosophy Heidegger’s own critique of philosophy.—J. D. C. (shrink)

From the translator of The Future of Mankind and The Future of Germany comes this most welcome English rendering of the first volume of Jasper's Philosophie, considered by many his main work. Of all the great figures of the existential-phenomenological movement--Kierkegaard, Nietzsche, Husserl, Heidegger, Sartre, Marcel--Jaspers has been the most neglected in the Anglo-American world. Jaspers alone among these figures has a work as important as his Philosophie still untranslated into English. This work, which consists of three volumes, was (...) originally published in 1932. The present edition contains: a 1955 Epilogue by Jaspers who comments on the intent of the book and the criticism it received; an "Introduction to Philosophy" which prefaces the body of Philosophy; and then the main body of this title: "Book One: Philosophical World Orientation." Here Jaspers carves out the proper structure of philosophy--not as a science which must compete with other sciences but as thinking concerned with man's place in the world and which regulates the role that science plays in man's world. There is, unfortunately, no index nor any glossary of German-English and English-German.--J. D. C. (shrink)

The present collection of essays was designed by translator David Lachterman to provide the reader with a better understanding of Scheler’s major work, Formalism in Ethics and Non-formal Ethics of Values, which will also be published in translation by Northwestern University Press. Lachterman provides us with an illuminating preface which sketches the general character of Scheler’s thought, particularly its relationship to Husserl and Heidegger, and which discusses each of the five selections. Four of the five essays presented here are incomplete (...) works, and three were never published in Scheler’s lifetime. The first, "The Idols of Self-Knowledge," is an attempt to differentiate psychical and physical phenomena and criticizes the way Brentano went about making this distinction. In "Ordo amoris" Scheler maintains with Augustine and Pascal, the priority of love over cognition. In "Phenomenology and the Theory Cognition," Scheler develops his own account of the phenomenological method. "The Theory of the Three Facts" represents Scheler’s views on the distinction between phenomenological, scientific and common sense "facts." The last essay is entitled "Idealism and Realism" and demonstrates "that it is a mistake to opt for either one of the parties to this conflict," and argues instead for a phenomenology of essences. The last section of this text, which was to be a confrontation of Scheler with the then recently published Being and Time, never appeared but is still awaiting publication in the critical edition of Scheler’s works. One welcomes Prof. Lachterman’s initiative in making available to the English reader these essays of one of the most significant figures in twentieth century German philosophy.—J. D. C. (shrink)

This is a collection of essays and lectures which have all been published previously. Heidegger prefaces the volume with a series of remarks, written in 1967, which elaborate upon the title Wegmarken. The path in question is what he has called on numerous occasions his Denkweg. The path is the way of thinking into the truly thought-worthy. The path goes back into what was once thought out and is now covered over, and forward into what is to be thought out (...) but is still concealed. The thinker en route to Being has had his thinking set in motion by Being itself. Thinking travels a troubled path, for it stands in constant danger of being flooded by mere information. Whether or not it can bypass this roadblock is still the essential question for our time. Three of the texts collected here were available only in journals and Festschriften. It is also interesting that Heidegger includes all three segments of Was ist Metaphysik? He does not fuse them into a single text but arranges them separately. The other selections are: Vom Wesen des Grundes; Vom Wesen der Wahrheit; Platons Lehre von der Wahrheit; Brief über den "Humanismus"; Zur Seinsfrage; Kants These über das Sein. Here we see what Heidegger himself has singled out as being representative of, and significant for, the course of his thought. The emphasis upon "path" argues strongly for those who would see in Heidegger's thought an evolving, developing growth. The unity of early and later Heidegger then is not the unity of a single doctrine but the unity of a single search or path, unified by a single object of pursuit.--J. D. C. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Sefler has written a helpful book on the question of the relationship between Heidegger and Wittgenstein which should contribute to clearing up the grounds upon which this discussion must take place. Sefler’s book, based on his 1970 doctoral dissertation, employs what he calls a "methodological" approach. Instead of comparing Wittgenstein and Heidegger directly in terms of the content of their thought, he claims it is more fruitful to compare them "relationally," using Carnap’s "structural descriptions." Thus in Part One, he argues (...) that while Heidegger is speaking of the things themselves and Wittgenstein of language, still for both thinkers philosophy is an "interpretative description," which, having renounced the ideal of a "pure" description, always sees a thing "as" something. (shrink)

Analysis of sites of newly integrated DNA in cellular genomes is important to several fields, but methods for analyzing and visualizing these datasets are still under development. Here, we describe tools for data analysis and visualization that take as input integration site data from our INSPIIRED pipeline. Paired-end sequencing allows inference of the numbers of transduced cells as well as the distributions of integration sites in target genomes. We present interactive heatmaps that allow comparison of distributions of integration sites (...) to genomic features and that support numerous user-defined statistical tests. To summarize integration site data from human gene therapy samples, we developed a reproducible report format that catalogs sample population structure, longitudinal dynamics, and integration frequency near cancer-associated genes. We also introduce a novel summary statistic, the UC50, which provides a single number summarizing possible clonal expansion. Using these tools, we characterize ongoing longitudinal characterization of a patient from the first trial to treat severe combined immunodeficiency-X1, showing successful reconstitution for 15 years accompanied by persistence of a cell clone with an integration site near the cancer-associated gene CCND2. Software is available at https://github.com/BushmanLab/INSPIIRED. (shrink)

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

Gottfried Wilhelm Leibniz was one of the first Modern philosophers, and as such, one of the most significant. His contributions were often pathbreaking and his imprint still remains on fields such as logic, mathematics, science, international law, and ethics. While publishing relatively little during his life, he was in regular correspondence with important philosophers and even political leaders.